When Silence Masks Autism: Delayed Autism Diagnosis in an Adolescent With Deafness

A 13-year-old adolescent male was referred for an interdisciplinary autism assessment. His complex medical history included a traumatic delivery (with drop in heartrate and nuchal cord), neonatal hyperbilirubinemia, diagnosis of profound congenital hearing loss, diminished bile ducts on liver biopsy at 1 month of age, and a seizure disorder. Later, he was diagnosed with a significant global developmental delay with minimal communication in any modality. The youth received cochlear implants at the age of 2 years but was unable to tolerate them. Despite early intervention services and multiple stays in urban academic medical centers, he was not considered for a diagnosis of autism because his problematic behaviors, sensory sensitivities, and social and communication delays were attributed to his hearing loss and intellectual disability. It was not until the age of 13 that he was confirmed to have autism via a comprehensive interdisciplinary assessment based on adapted, standardized, evidence-based tools and expert clinical observations. This case highlights the importance of understanding and identifying the differences between hearing loss related behaviors and possible symptoms of a co-occurring neurodevelopmental disorder as well as the peril of diagnostic overshadowing in children with hearing loss.